Signet Ring Cell Adenocarcinoma Research Articles

Systematic Review: Seventy-Seven Cases of Signet Ring Cell Adenocarcinoma of the Bladder

Background: Signet ring cell adenocarcinoma (SRCC) of the bladder is a rare and aggressive histological subtype of bladder cancer. Due to its infrequency, the understanding of its clinical behaviour, treatment strategies, and outcomes remains limited, being primarily derived from isolated case reports and series. Objective: To systematically review and analyse the available literature on SRCC of the bladder, emphasizing its clinical characteristics, diagnostic approaches, treatment modalities, and outcomes. Material and Methods: A comprehensive search was conducted across PubMed, Embase, and Medline following the PRISMA guidelines, including case reports, case series, observational studies, and clinical trials reporting on bladder SRCC. Results: We included 38 articles reporting on 77 patients, primarily males (79.2%), with a median age of 64 years. The most common presenting symptoms were haematuria (64.8%) and lower urinary tract symptoms (46.3%). All the diagnoses were based on histopathological examination of bladder tissue samples and immunohistochemistry. Mixed histological types of bladder cancer were found in 20.7% of cases, most commonly urothelial carcinoma (61.1%). The treatments varied, with 53.2% of patients undergoing radical cystectomy, 24.7% receiving radiotherapy, and 16.9% receiving chemotherapy. The five-year survival rates were 9.4%. Conclusion: Bladder SRCC presents aggressively, with varied treatment strategies; however, radical cystectomy appears to be the optimal means of surgical management for organ-confined disease. The overall survival rate is low, highlighting the need for further research to understand and manage this rare bladder cancer variant. All patients should undergo evaluation to exclude extravesical primaries. This systematic review contributes to a better understanding of this disease and may guide clinical management strategies.

In vivo model of colorectal cancer: impact to cigarette smoke exposition on neoplasm development

Our proposal aims to investigate the impact that exposure to cigarette smoke has on the development of lesions in the colorectal mucosa of in vivo model of colorectal carcinogenesis. For that, 24 young male rats were induced to colorectal carcinogenesis and separated into two groups: exposure to cigarette smoke for 20 weeks (DMH+/Tobacco+) and control (DMH+/Tobacco-). In the group (DMH+/Tobacco+), 14.7% dysplasia and 85.29% malignant neoplasms were observed, including tubular adenocarcinoma (73%), carcinoma in situ (17%) and signet-ring cell adenocarcinoma (10%). Mononuclear inflammation and pleomorphisms were mild to moderate. In the control group, there was 7.69% dysplasia, 7.69% tubular adenoma and 84.62% malignant neoplasms, including tubular adenocarcinoma (82%), signet-ring cell adenocarcinoma (9%), carcinoma in situ (5%) and mucinous adenocarcinoma (4%). Mononuclear inflammation and pleomorphisms were moderate to severe. Thus, the experimental model showed that the lesions were predominantly malignant and with histopathological characteristics compatible with human colorectal cancer, including its possible applications for future studies.

Diagnostic Pitfall of Gastric Signet-Ring Cells: How to Diagnose a Benign Signet-Ring Cell From a Malignant One.

Sometimes non-neoplastic changes of the gastric mucosa mimic diffuse-type gastric carcinoma, specifically signet-ring cell adenocarcinoma. In fact, gastric epithelial cells undergoing signet-ring cell change have a cellular morphology that is almost identical to signet-ring cell adenocarcinoma, often leading to misdiagnosis. Accurate recognition of signet-ring cell change is essential to avoid overdiagnosis and overtreatment of signet-ring cell adenocarcinoma. Research on this topic is limited and clinicians lack formal diagnostic tools when signet-ring cells are detected in biopsy specimens. The aims of this study are 3-fold. Firstly, to increase the awareness of both clinicians and pathologists of this rare but highly significant entity. Secondly, to report 4 additional examples of signet-ring cell change and analyze them alongside signet-ring cell adenocarcinoma to compare their morphological and phenotypic features and their evolution over time. Finally, to highlight the potential utility of endoscopic resection to confirm the diagnosis. Cells in signet-ring cell change strongly express E-cadherin, show a wild-type p53 expression, and have a low Ki67 index. In contrast, cells in signet-ring cell adenocarcinoma strongly express p53, have high proliferation rates, and show either no or weak E-cadherin staining. Genetic analysis may be useful in identifying patients at risk of hereditary early diffuse gastric adenocarcinoma, which can mimic signet-ring cell change.

Gastric signet-ring cell adenocarcinoma masquerading as sarcoidosis

Gastric signet-ring cell adenocarcinoma masquerading as sarcoidosis

Early Gastric Signet Ring Cell Adenocarcinoma as a Flat Pale Patch on an Esophagogastroduodenoscopy.

Early Gastric Signet Ring Cell Adenocarcinoma as a Flat Pale Patch on an Esophagogastroduodenoscopy.

Retraction: Primary signet ring cell adenocarcinoma arising in exstrophy of the urinary bladder (epispadias exstrophy complex)

Retraction: Primary signet ring cell adenocarcinoma arising in exstrophy of the urinary bladder (epispadias exstrophy complex)

A160 A CASE OF BREAST CANCER METASTASIS MASQUERADING AS SIGNET RING CELL ADENOCARCINOMA OF THE STOMACH

Abstract Background Gastric cancer has a poor prognosis, particularly at advanced stages. Endoscopic submucosal dissection (ESD) can be used to treat selected early-stage gastric cancers. This case study explores the challenge of diagnosing and managing patients when metastatic lesions mimic primary gastric cancer, as seen in this case of breast cancer metastasis resembling signet ring cell adenocarcinoma of the stomach. Aims The aim of this case report is to describe an unusual case of breast cancer metastasis to the stomach identified unexpectedly on random gastric biopsies, initially diagnosed as a primary gastric signet ring cell adenocarcinoma. Methods Clinical and pathological records of the described patient were reviewed retrospectively. Furthermore, a review of the relevant literature was also performed. Results A 68 year-old-woman underwent gastroscopy for nausea and vomiting. Her past medical history was remarkable for bilateral mastectomies ten years ago for invasive lobular carcinoma, with metastatic bone disease diagnosed by imaging five years prior. She had been well controlled on letrozole taken intermittently due to side effects. At endoscopy, while the stomach appeared grossly normal, random biopsies done for Helicobacter pylori identified a single focus of signet ring cell adenocarcinoma. Subsequent chromoendoscopy identified an area of subtle mucosal abnormality for which the patient declined surgery and was instead managed by ESD which surprisingly yielded no dysplasia. A follow up gastroscopy with random biopsies also failed to identify any areas of dysplasia, but random biopsies on a subsequent gastroscopy again identified a minute focus of adenocarcinoma with signet ring cell morphology. Given the unusual presentation of apparent signet ring cell adenocarcinoma in two distinct areas in the stomach without any visible endoscopic abnormality an in-depth pathological analysis was conducted. By immunohistochemistry the tumor cells stained positive for Estrogen Receptor, GATA3, and CK7 and negative for antibodies targeting CK20 and CDX2, which supported an interpretation of minute multifocal breast cancer metastases to the stomach from hematogenous spread. Conclusions In this case, repeated endoscopic investigations and immunohistochemical staining revealed minute multifocal breast cancer metastases to the stomach. Conventional tumor staging methods often cannot identify microscopic metastases, potentially impacting disease progression and patient care. A high level of suspicion for metastatic breast cancer and a detailed pathological analysis allowed for the correct diagnosis in this patient. Funding Agencies None

Signet ring-cell colorectal adenocarcinoma: review and clinical case

Colorectal cancer is one of the most common malignancies in the general population and has many histological subtypes. Signet-ring cell adenocarcinoma is a rather rare variant of this pathology. It is characterized by molecular genetic and morphological features that are absent in classical adenocarcinomas, which causes some nuances in the clinical course and approach to therapy of this type of tumor. In our clinical case, a 68-year-old patient went to a general practitioner with complaints of abdominal pain, changes in the act of defecation, and according to the primary physical and instrumental examination, he was diagnosed with chronic distal colitis, and later he was prescribed anti-inflammatory therapy. However, six months later, the patient went to the doctor again with complaints of worsening condition and symptoms, after examination, he was diagnosed with adenocarcinoma of the sigmoid colon, but due to low adherence to treatment, as well as late diagnosis, the patient died within six months. Surgical treatment of the patient was limited to resection of the sigmoid colon due to peritoneal adhesions. In the postoperative period, the development of fibrinous-purulent peritonitis and increasing cardiovascular failure were clinically noted. At autopsy, the histological variant of the lesion was changed to the signet-ring cell form with metastasis to the liver and greater omentum. Death occurred from disseminated intravascular coagulation syndrome with the development of acute renal failure and centrilobular necrosis of the liver. Clinical observation emphasizes the importance of introducing modern molecular diagnostic methods into wide practice.

Comparison of Clinicopathological Characteristics of Patients with Early and Late-onset Colorectal Adenocarcinoma: A Cross-sectional Study

Introduction: Colorectal Cancer (CRC) has been primarily considered a disease of the elderly, but recent data have shown an alarming rise among young people. It has also been suggested that young age is associated with aggressive histopathological characteristics and advanced stages of the disease at diagnosis. Aim: To assess and compare the clinical and pathological characteristics of patients with rectal cancer diagnosed at ages over and below 45 years. Materials and Method: This prospective cross-sectional study was conducted between January 2020 and August 2022 in the Departments of Surgical, Medical, Radiation Oncology, Surgical Gastroenterology, and General Surgery at All India Institute of Medical Sciences (AIIMS) Rishikesh, Uttarakand, India. All patients underwent a biopsy from the representative site for histological documentation of the disease. They then underwent treatment (surgery/chemotherapy/radiotherapy) as required. All the data were categorised into two groups: an early-onset group (age <45 years) and a late-onset group (≥45 years). A comparison of the clinicopathological characteristics (age, gender, comorbidities, tumour subsite, clinical presentation, clinical stage, etc.), pathological data (grade and differentiation of tumour, as per World Health Organisation (WHO) grading system), and serum Carcinoembryonic Antigen (CEA) levels between the two groups was performed. The association between categorical variables was investigated using the Chi-square test. The mean difference was assessed using an independent t-test. A p-value of 0.05 or below was considered statistically significant. Results: A total of 51 patients with rectal cancer, 35 males and 16 females, were included in the study. The mean age was 44.73±16.47 years. Out of the total of 51 (100%) patients, lower rectum involvement was seen in 22 (43.1%) patients, followed by 7 (13.7%) patients each with ascending colon and sigmoid involvement resepectively. However, the Chi-square test showed no statistically significant association of location involved with age groups (χ2 =9.09; p=0.16). Out of 51 (100%) adenocarcinoma patients in total, three patients each under 45 years of age had signet cell adenocarcinoma and mucinous adenocarcinoma (χ2 =7.07; p=0.029). Among the total of 51 (100%) patients, moderately differentiated lesions were seen in 17 (33.3%) patients, poorly differentiated lesions were seen in 15 (29.4%) patients, and well-differentiated lesions were seen in 10 (19.6%) patients (χ2 =13.01; p=0.005). Conclusion: Younger patients tended to have larger tumours that were of a higher grade and had signet ring or mucinous histopathology. The social and clinical implications of these findings are to be explored.

Curschmanns Spirals in Pleural Effusion in a 66-Year-Old Male with a History of Gastric Signet Ring Cell Adenocarcinoma with No Evidence of Metastasis

Curschmanns Spirals in Pleural Effusion in a 66-Year-Old Male with a History of Gastric Signet Ring Cell Adenocarcinoma with No Evidence of Metastasis

Location Has Prognostic Impact on the Outcome of Colorectal Mucinous Adenocarcinomas.

Mucinous (colloid) adenocarcinomas (MAs) are a rare histological subtype of tumors defined by extracellular mucin comprising more than 50% of the tumor. These tumors are on a continuum of mucin-producing malignancies with signet ring cell adenocarcinomas (SRCCs), which instead produce intracellular mucin. Mucin-containing cancers occur primarily in the stomach and colon, where for SRCCs, outcomes are relatively worse in the proximal stomach and the rectum. It is not known if MAs have similar outcomes. In this study, we use the Surveillance, Epidemiology, and End Results (SEER) database to examine the effects of tumor localization, age, sex, and stage on colorectal and gastric cancer outcomes for MAs. For right colon cancers, MAs are more common, particularly in females, and have slightly better or equivalent outcomes across all stages and ages compared to conventional adenocarcinomas, but outcomes are progressively worse compared to conventional adenocarcinomas for left colon and rectal cancers. Unlike SRCCs, MAs have similar outcomes to conventional adenocarcinomas in all stomach locations. Overall, these results suggest that MAs have an intrinsically different tumor biology in the left colon and rectum that promotes pathogenesis. Decoding this phenomenon could lead to more effectively tailored patient treatment regimens.

Malignant Transformation of Long-Standing Ileal Crohn's Disease Likely Favors Signet Ring Cell Adenocarcinoma Histology.

Signet ring cell adenocarcinomas (SRCCs) are a rare and aggressive histological subtype of adenocarcinomas typically with poor prognosis usually secondary to late stage at detection. In the small bowel, they constitute only 1% of all malignancies. In the last decade, there have been multiple case reports and small case series that have identified SRCCs, typically in the ileum, in patients with Crohn's disease. Crohn's disease is a transmural inflammatory condition that normally manifests in the distal ileum and colon, and is known to temporally increase the risk of malignancy. Given the profound rarity of SRCCs, establishing an association between Crohn's disease and SRCC is challenging. In this study, we performed a systematic review of case reports and small case series describing small bowel SRCCs in Crohn's disease patients. Most cases were found in the distal/terminal ileum, at a mean age of 59 years old. Virtually all tumors were locally advanced (pathological T stage 3 and 4), typically with at least N1 nodal disease. Two case studies (one is a case-control study and the other a cohort design) demonstrated that small bowel SRCC, as opposed to conventional adenocarcinoma, was significantly correlated to a history of Crohn's disease (35% vs. 0%, 73.5% vs. 28.5%), with a propensity to arise in the ileum (95% vs. 30%, 66.7% vs. 42.1%), and at earlier mean age (43 vs. 68 years, 53.7 vs. 61.7 years). We additionally used the Surveillance, Epidemiology, and End Results (SEER) database for insights into the clinicoepidemiological characteristics of ileum SRCCs. SRCCs composed 28.1% of all ileal SRCCs, compared to 11.0% for the adenocarcinomas, with a younger age at diagnosis (60.7 vs. 64.6 years), more distant disease at presentation (41.3% vs. 26.4%), and shorter overall median survival time (20 vs. 39 months). In summary, while there is limited direct evidence to support an association between small bowel SRCC and Crohn's disease, the phenomenon has been increasingly documented in the literature in the last decade. Clinicians treating Crohn's disease patients should consider this in their differential diagnosis, particularly when managing disease complications, as early detection and surgical intervention offer the best prognosis.

A descriptive analysis of gastric cancer with an immunohistochemical Study of Ki67 and p53 as prognostic factors.: Bahrain experience.

To describe the increasing number of gastric cancer cases at Bahrain Defense Force Hospital with implementation of immunohistochemistry markers as prognostic factors. This study included histologically confirmed malignant gastric tumors diagnosed at Bahrain Defense Force Hospital from January 2009 to June 2019. Various epidemiological and pathological data were abstracted and recorded with immunohistochemical analysis of the proliferation marker Ki67 and cell-cycle regulator p53 as prognostic factors. A total of 53 patients with gastric cancer were included in the study, with mean age of 59.75 ± 12.9 years. The typical histological types were signet ring cell adenocarcinoma (68%) and intestinal type adenocarcinoma (17%). Helicobacter pylori and intestinal metaplasia were significantly associated with gastric cancer (p<0.01). The studied population's mortality was 39 (74%). The Ki67 proliferation index showed a mean and standard deviation of 67.09 ± 16.338, with a higher mortality rate in patients with low Ki67 but no difference in survival time. No statistically significant association was found between clinicopathological findings with p53 immunostaining positivity. The common gastric cancers are signet ring cell adenocarcinoma and intestinal type adenocarcinoma, affecting a wide range of age groups (33-91 years), with those over 60 years at greater risk. Interestingly, low Ki67 is associated with a higher mortality rate, whereas p53 has no prognostic significance. Expression of both Ki67 and p53 showed no association with survival time.

Primary signet ring cell adenocarcinoma arising in exstrophy of the urinary bladder (epispadias-exstrophy complex).

Bladder exstrophy is a rare congenital anomaly in which the urinary bladder develops outside the body. It may be part of the bladder epispadias-exstrophy-cloacal complex, which is a serious embryological defect where a spectrum of abnormalities involving the urinary tract, genital tract, musculoskeletal system, and intestinal tract is seen. Primary signet ring cell adenocarcinoma (PSRCA) arising in exstrophy of the urinary bladder is extremely rare with only a few cases reported in the literature. A 32-year-old man with congenital, untreated bladder exstrophy presented with a large fungating mass on the lower abdominal wall. Physical examination revealed a 15 × 12 cm exophytic mass with a penile epispadias. Ultrasonography showed a replacement of the urinary bladder by a mass of size 9 × 8 × 7 cm with a defect in the abdominal wall. On Contrast-enhanced computed tomography (CECT), a mass protruding from a large, inferior abdominal wall defect of 5.3 cm was seen. Widened pubic symphysis with divarication of recti and an absent urinary bladder, consistent with bladder exstrophy, was also noted. The biopsy showed a signet ring cell adenocarcinoma. A radical cystectomy with ileal conduit and left inguinal lymph node dissection was done. Histopathology examination revealed a PSRCA with metastasis to the left inguinal lymph nodes. Immunohistochemistry (IHC) showed strong positivity with CDX2 and CK20 while CK7 was negative. PSRCA shows an aggressive behavior, as was seen in our case, which had metastatic inguinal lymph nodes at the time of presentation. Metastatic signet ring cell adenocarcinomas from other sites need to be ruled out. Bladder exstrophy can develop high-grade malignancies at any stage of life. Hence, surgical treatment early in life with lifelong follow-up is recommended.

S4153 Metastatic Signet Ring Cell Adenocarcinoma Manifesting as Chronic Leg Pain

S4153 Metastatic Signet Ring Cell Adenocarcinoma Manifesting as Chronic Leg Pain

S4067 Beyond the Obstruction: Unveiling Signet Ring Cell Adenocarcinoma's Intriguing Presentation

S4067 Beyond the Obstruction: Unveiling Signet Ring Cell Adenocarcinoma's Intriguing Presentation

An interesting case of gastric adenocarcinoma presenting as bicytopenia in young adult

Abstract A 28-year-old male with no prior comorbidities came with chief complaints of loss of weight for 4 months, generalised weakness for 1 month and blackish discolouration of stools for 20 days. On general examination, pallor present; rest of the physical examination was normal. Laboratory investigations showed low haemoglobin (4.8 g/dL) and platelet count (10,000/mm3). Atypical cells were present in the peripheral blood smear and accounted for 4%. packed red blood cells and platelet-rich plasma transfusions were given. As the blood counts were not improving, bone marrow aspiration and biopsy were done which showed metastatic signet-ring cell carcinoma. In view of melaena, endoscopy was done, which showed carcinoma stomach with active bleeding. The patient was diagnosed to have metastatic signet-ring cell adenocarcinoma with bone marrow metastasis. In view of the advanced nature of disease, the patient was given palliative and supportive treatment.

Gastric Signet-Ring Cell Adenocarcinoma in a Dog

Gastric Signet-Ring Cell Adenocarcinoma in a Dog

CLINICO-HISTOPATHOLOGICAL ANALYSIS OF PRE-MALIGNANT AND MALIGNANT LESIONS OF THE INTESTINAL TRACT

Aim: The current study’s aim is to correlate clinical variables with histopathological findings of pre-malignant and malignant lesions of the intestinal tract. Methods: The sample size includes all the endoscopic biopsies and surgically resected specimens of the intestinal tract received at the Department of Pathology, S.V. Medical College, Tirupathi for 2 years from November 2016 to October 2018. All the specimens are fixed in 10% formalin and stained with Hematoxylin and Eosin. Special stains and Immunohistochemistry were done wherever required. Results: During the study, we studied 113 specimens of endoscopic biopsies and 759 specimens of surgically resected. Out of 113 endoscopic biopsies, 33 biopsies were premalignant and malignant lesions, among which 8 were premalignat lesions and 25 were malignant. Out of 759 surgically resected specimens, 37 specimens were premalignant and malignant lesions, among which 1 was premalignant and 36 were malignant. Out of 70 lesions, 3 occurred in the small intestine, 59 occurred in large intestine, 8 occurred in the anal canal. In the small intestine, 3 lesions were encountered among which, one each of adenoma, PJP, adenocarcinoma was noted. Out of 59 lesions of large intestine 4 were adenomas, 2 were ulcerative colitis, 48 were adenocarcinoma and its variants, 2 were MANECs, one each of carcinoid and GIST and malignant melanoma were reported. In the anal canal, there were 1 adenoma, 2 mucinous adenocarcinomas, and 5 squamous cell carcinomas reported. A case of adenoma occurred in male patient, among 2 mucinous adenocarcinomas one occurred in female patient and one in male patient. Out of 5 squamous cell carcinomas, 3 occurred in female patients and 2 in male patients. Among 3 lesions of the small intestine, one case each of adenoma, PJP, and adenocarcinoma, all occurred in male patients. 33 out of 48 adenocarcinomas occurred in male patients. The most common symptom was bleeding per rectum (63.83%) followed by constipation, pain in abdomen and diarrhea. The association between Adenocarcinoma and Smoking is not correlated with p=0.67. The association between Adenocarcinoma and Smoking is not correlated with a p=0.38. Conclusion: Most of the neoplasms were from the large intestine followed by the anal canal. The most common neoplasm and also most common malignancy was Adenocarcinoma. Different variants of adenocarcinoma encountered in the study were Mucinous adenocarcinoma and Signet ring cell adenocarcinoma. Adenomas were common in Male patients. Mixed adenoneuroendocrine tumor and gastrointestinal stromal tumor of large intestine were confirmed with IHC study.

Systemic Chemo in Patients With Appendix Adenocarcinoma

Systemic Chemo in Patients With Appendix Adenocarcinoma